Provider Demographics
NPI:1710938030
Name:LONGO, DANIEL PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PHILIP
Last Name:LONGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 JORALEMON ST
Mailing Address - Street 2:UNIT 194
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:973-580-3068
Mailing Address - Fax:973-661-9141
Practice Address - Street 1:715 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110
Practice Address - Country:US
Practice Address - Phone:973-661-2303
Practice Address - Fax:973-661-9141
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00614200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor